Dental and Oral Health (Adults)

Tongue lump

03/04/2010

Question:

A few days ago, a small lump appeared on the top of my tongue, just a little off center and about 1/3 of the way back. It’s pea-sized and doesn’t come up very far. It doesn’t hurt, but really feels weird. When it first appeared, there was no coloring, but now it’s a little lighter than normal tongue color.

I’m 37, don’t smoke and only drink occasionally. Everything I’ve read says that cancerous lumps are found on the side, bottom, or under the tongue. I’ve never experienced any lumps/lesions in any of those places.

I’d just like an expert opinion, since I haven’t really found anything that describes what I have. I’m a bit of a hypochondriac, so this is freaking me out a bit. Any advice would be appreciated. Thanks.

Answer:

Sorry for the delay in responding to your concern of the lump/bump on your tongue.

There are many possibilities of the cause of such things, and if you are very concerned or this continues or becomes larger, you should see your primary care provider or your dentist to have it evaluated.

There is a "grocery list" of possible lesions that can present on the dorsum of the tongue, that range from an irritation fibroma to mesenchymal tumors. Majority of "lumps/bumps" on the top surface of the tongue are related to some form of trauma that occurs with biting or chewing. The fibroma is a proliferation or over growth of fibrous connective tissue that results from some form of irritation or trauma, and is the most common. Treatment is excisional biopsy and histological evaluation by an oral pathologist to rule out significant pathology.

The next possibility is a mucocele or mucous extravasation phenomena. These usually occur on the ventral floor of mouth side of the tongue and are the result of a blocked salivary gland duct and resultant abnormal collection of saliva retained within the tissue; they can come and go as a result of rupture. In most cases, definitive treatment (surgery) is not indicated.

Another possible lesion is the granular cell tumor, a dorsal surface (top) lesion that develops in person 40-60 years of age (age predilection, and rare in children), that is asymptomatic and is fairly small in diameter. The lesion is often present and observed by the patient for many months even years but some individuals are unaware of its presence and it is detected during oral examination. Etiology (cause of disease) is unknown and treatment is by excisional biopsy.

The pyogenic granuloma is another somewhat common lesion that can occur on the dorsum or top of the tongue. History of trauma (biting the tongue) is common event that precedes the lesion, and there is an increased frequency of occurrence during pregnancy.

The lesion appears like a cluster of grapes or an oversized red purple grape (very vascular and can be ulcerated, and bleed upon probing). Treatment is excisional removal and histological evaluation to confirm diagnosis. During pregnancy treatment is usually deferred and the lesion usually goes away on its own.

Other tongue lesions exist in a grocery list differential and require a thorough oral examination and history to sort through and come up with a definitive diagnosis. The additional possibilities include such disease entities as the neurofibroma, hemangioma, lymphangioma, or osseous or cartilagenous choristomas. Finally since I have not seen the lesion I would not rule out squamous cell carcinoma, until I evaluated and biopsied the site.

In all reality, it is probably something very benign, but if you are concerned, I would highly recommend having it evaluated.

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